Provider Demographics
NPI:1649423021
Name:IOWA JEWISH SENIOR LIFE CENTER
Entity Type:Organization
Organization Name:IOWA JEWISH SENIOR LIFE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-255-5433
Mailing Address - Street 1:900 POLK BLVD
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-2225
Mailing Address - Country:US
Mailing Address - Phone:515-255-5433
Mailing Address - Fax:515-277-8898
Practice Address - Street 1:900 POLK BLVD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-2225
Practice Address - Country:US
Practice Address - Phone:515-255-5433
Practice Address - Fax:515-277-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0802025Medicaid
165006Medicare Oscar/Certification